J U LY 2 0 1 6 O U T P A T I E N TS U R G E R Y. N E T 1 3
a combination of greater surgical offerings, higher
BMIs and competing pressures regarding which
patients to accept and which to reject.
While it's true that many surgery centers may still
be inclined to steer larger and sicker patients
toward hospitals, even conservative ambulatory
facilities put themselves at risk if they're unwilling
to invest in cutting-edge equipment, says Dr.
Randall. "It's especially important in outpatient cen-
ters, because you don't have the backup you might
have elsewhere. When you have a difficult airway,
all hands need to be on deck," she says. "But some-
times you're at a facility where, tag, you're it."
Dr. Randall says working without skilled backup
is a definite problem if you don't have visualization
of the airway, because at that moment, you may
need another provider skilled in airway manage-
ment to offer assistance. "Sometimes you're dealing
with patients with broad faces and full beards, and
it becomes a two-hand technique just to be able to
mask them effectively," she explains.
It's challenging and nerve-wracking to manage air-
way emergencies in extremely obese patients, who
have very little functional reserve capacity in their
lungs, says Dr. Randall. "So if they start to desatu-
rate, you don't have much time," she adds. "And it's
very hard to try to oxygenate them back to a nor-
mal level. The same is true with kids. They can
desaturate quickly, but are much more resilient in
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